The Influence of Setting on Care Coordination for Childhood Asthma - PowerPoint PPT Presentation

The Influence of Setting on Care Coordination for Childhood Asthma A Webinar Presented by the Merck Childhood Asthma Network, Inc. September 24, 2013

Webinar Instructions • Audio – This is an audio/web broadcast where the audio will be transmitted through your computer speakers. Please make sure your speakers are turned on and not muted. – Upon entering the event, there will be an audio broadcast window where you can adjust volume. – If you are unable to connect to the webinar using your computer speakers or having audio difficulties, please use the following dial-in information: • Number: 1-866-246-1076 • Passcode: 9936154608 – Your line will be muted • Questions – If you have a question during the webinar, please click on the “Q&A” tab at the right of your screen and send it to “All Panelists.” If you are directing your question to a specific presenter, please write their name before the question (e.g., Malveaux, Clark, Persky, Lara, Uyeda, Bryant-Stephens). – Due to the large number of participants, we will answer as many questions as possible within the time frame allotted for this webinar. If your question was not answered, we encourage you to reach out to the individual presenter via e-mail following the webinar (email addresses will be provided at the end of the presentation).

Today’s Agenda and Presenters Challenges of Childhood Asthma/How Care Coordination Can Help Dr. Floyd Malveaux, Merck Childhood Asthma Network, Inc. Care Coordination/How it Can Help Children with Asthma Dr. Noreen Clark, University of Michigan School of Public Health Coordinating Asthma Care for Children in an Urban Community Dr. Victoria Persky, University of Illinois at Chicago School of Public Health Community-Partnered Asthma Care Coordination Dr. Marielena Lara, RAND Corporation Asthma Care Coordination in a Large Urban School District Dr. Kimberly Uyeda, Los Angeles Unified School District Care Coordination Within an Urban Pediatric Hospital System Dr. Tyra Bryant-Stephens, Children’s Hospital of Philadelphia

The Challenges of Childhood Asthma and How Care Coordination Can Help Floyd J. Malveaux, M.D., Ph.D. Executive Director Merck Childhood Asthma Network, Inc. (202) 326-5200 floyd_malveaux@merck.com

The Merck Childhood Asthma Network, Inc. (MCAN) is a nonprofit 501(c)(3) organization founded in 2005 and funded by The Merck Foundation MCAN’s Mission Enhance the quality of life for children with asthma and their families, and reduce the burden of the disease on them and society. Strategic Priorities 1. Fund implementation of Evidence Based Interventions in health care settings and communities to enhance access to and quality of care 2. Advocate for policies that are science-based and cost-effective 3. Enhance awareness and knowledge of quality asthma care Goals Through research, community programs and partnerships, MCAN is working to: – Improve access to and the quality of asthma healthcare services for children, especially those who are vulnerable and medically underserved – Advocate for policies that expedite implementation, dissemination and sustainability of science-based asthma care – Increase awareness and knowledge of asthma and quality asthma care

Childhood Asthma Is Challenging On Many Levels • Most common chronic condition among children • 1 in 7 ever diagnosed • Prevalence and morbidity highest among Widespread and Serious minority children • 55% had at least one asthma attack in the previous year • Second most costly condition in children • $8-10 billion in medical expenditures Costly • Additional $10 billion in indirect costs • 40% higher emergency department costs Preventable and Avoidable

Controlling Asthma Requires a Multi-Faceted Approach Like Care Coordination Access to primary and specialty care Access to social services, insurance coverage MCAN Care Coordination Programs Ongoing education and case management Identification/ mitigation of environmental triggers

MCAN Programs Use Care Coordination to Improve Life for Children with Asthma Care Coordination Program Sites (Chicago, Los Angeles, Philadelphia and Puerto Rico) Head-Off Environmental Asthma In Louisiana (HEAL), Phase I and II Community Healthcare For Asthma Management & Prevention Of Symptoms (CHAMPS)

Noreen M. Clark What Is Care Coordination and How Can Shelley Stoll Patrick Kelly it Help Children with Asthma? University of Michigan Noreen M. Clark, PhD Myron E. Wegman Distinguished University Professor Director, Center for Managing Chronic Disease, University of Michigan School of Public Health (734)763-1457 nmclark@umich.edu

What Are The Problems? Insufficient patient/ Symptoms not controlled   family education Increased ED visits  Insufficient clinical Increased   follow-up hospitalizations Fractured health care Activity limitations   Lack of communication Lower quality of life   with schools, day care Missed school days  Psychosocial stressors Missed parent work days   Unhealthy home  environments  ETS, mold, pets, pests, dust

What Do We Mean by Care Coordination ? 'Care coordination' is a client-centered , assessment-based interdisciplinary approach to integrating health care and social support services in which an individual’s needs and preferences are assessed , a comprehensive care plan is developed, and services are managed and monitored by an identified care coordinator following evidence-based standards of care - National Coalition on Care Coordination

Asthma Care Coordinators (ACCs) Titles of ACCs vary: Community Health Educator [Chicago] • Health Educator and Community Health • Worker [San Juan] Asthma Care Navigator [Philadelphia] • Asthma Nurse [Los Angeles] • ACCs: Understand the culture of those they serve • Assess asthma control and other • mediating factors Provide education and referrals • Make home visits • Encourage clinical follow-up • Provide continuity •

Basic Care Pathway • Intake and Intake and assessment forms completed • May take place in clinic, home, or community Assessment • Baseline Education on asthma management • Baseline home environment assessment Home Visit • Provision of supplies to remediate triggers in home • Provide referrals as needed • Follow-up Calls Monitor asthma control • Follow-up on or continue education or Clinic Visits • Follow-up on clinical visits • Monitor asthma control Follow-up • Follow-up on education and clinical visits home visit(s) • Follow-up on use of trigger remediation supplies • Follow-up Monitor asthma control • Follow-up home environment assessment • Education as needed • Program exit process

Types of Referrals Provided Social Services: Addressing Environmental • Child care services, Triggers: parenting • Smoking cessation programs classes, Headstart • Home repair • Housing • Pest management • Employment website • Housing relocation • Asthma camp • Food pantry Insurance Coverage: Medical Care: • Enrollment assistance • School clinic • BreathMobile program • Government health plan • Mental health department • Medical centers administration

The Institutions and Settings Academic researchers in partnership with multiple • providers and organizations serving a defined urban geographic community [Chicago] Academic researchers in partnership with a Federally • Qualified Health Center serving an urban geographic community [San Juan] Within Nursing Services of a large urban school district • [Los Angeles] Within an urban pediatric health care system • [Philadelphia]

Addressing Asthma in Englewood Project: Coordinating Asthma Care for Children in an Urban Community Victoria Persky, M.D. University of Illinois at Chicago School of Public Health (312) 996-4783 vwpersky@uic.edu

Addressing Asthma in Englewood Project: Who’s the Target Population? • Englewood & West Englewood and 10 blocks around their boundaries • Health care providers in target area • Community members, school staff, students • Families with asthmatic child • Ages 0-18 years

Asthma Coordinators Are… • Community-based/resident • Trained and knowledgeable about asthma • A link between family, health care provider, school and social services

The Need to Reach the Target Population Influenced Project Design • Underserved community with predominately independent health providers • School screenings maximized initial reach • Health providers and community groups supplemented screenings in Phase I • Phase II focus shifted to health care providers to facilitate integration – decreased potential reach

Developing Trust, Partnerships Key to Clinical Integration • Partnerships were established with two Federally Qualified Health Centers (FQHCs) and multiple individual providers due to lack of a central health care facility • Implementation with multiple providers required trust, flexibility and follow through • Implementation with each provider was based on level of infrastructure and facility support